MEDICARE: MIRIAM STEWART DEHART MPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11584	SC

General Provider Information

NPI Number	:	1538615349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM STEWART DEHART MPT

Provider Business Mailing Address
First Line	:	69 TOWNE DR
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4201
Country	:	US
Telephone Number	:	484-515-1023
Fax Number	:	843-969-2000

Provider Business Practice Location Address
First Line	:	69 TOWNE DR
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29910-4201
Country	:	US
Telephone Number	:	484-515-1023
Fax Number	:	843-969-2000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	06/29/2026

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